One-third of US adults with type 2 diabetes have evidence of subclinical CVD

Elizabeth Selvin, PhD, MPH

Credit: Johns Hopkins University

About 1 in 3 adults in the United States with type 2 diabetes (T2D) showed subclinical signs cardiovascular disease (CVD) as assessed by cardiac biomarkers, according to new research.¹

The analysis suggests that subclinical CVD was strongly associated with an increased risk of mortality in adults with T2D, even after adjusting for various demographic characteristics and cardiovascular risk factors, highlighting the need for greater prevention efforts.

“What we find is that many people with T2DM who have not had a heart attack or a history of CVD are at high risk for cardiovascular complications,” said Elizabeth Selvin, PhD, MPH, professor of epidemiology at the Johns Hopkins Bloomberg School of Public. Health said in a statement.² “When we look at the entire population of people diagnosed with T2D, approximately 27 million adults in the United States, according to the CDC, some are low risk and some are high risk for CVD, so the question open is ‘Who is most at risk?’ These cardiac biomarkers give us a window into cardiovascular risk in people who might not otherwise be recognized as most at risk.

A 2022 consensus report from the American Diabetes Association recommended annual testing of biomarkers, including high-sensitivity cardiac troponin (hs-cTn) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) to enable early detection and prevention of heart disease. failure. Previous evidence suggests that elevations in both cardiac biomarkers may confer a substantial risk of major cardiac events and mortality in adults with diabetes. However, there is a lack of national data and little is known about the burden and long-term consequences of subclinical CVD in adults with T2DM in the general population.

The primary objective of the current analysis was to characterize the national prevalence of subclinical cardiovascular disease, as assessed by elevated hs-cTnT and NT-proBNP, among adults in the United States with and without diabetes. Participants were enrolled in the National Health and Nutrition Survey (NHANES) from 1999 to 2004. The population for analysis included non-pregnant adults aged ≥20 years without self-reported cardiovascular disease and with valid measures of NT-proBNP, hs-cTnT and covariates (n=10,304).

Participants were categorized as having no diabetes, newly diagnosed diabetes (≤ 1 year or no self-reported diagnosed diabetes and HbA1c ≥ 6.5%), short duration diabetes (self-reported diagnosis between 1 and 10 years) and a long duration of diabetes (≥ 10 years). Investigators defined subclinical CVD as having elevated levels of hs-cTnT (≥14 ng/L) or NT-proBNP (≥125pg/mL), measured using stored blood samples and determined status mortality by linking to the national baseline death index through December 2019.

From 1999 to 2004, 7% of US adults with no history of CVD had diabetes, were generally older, and had a higher burden of cardiovascular risk factors. After analysis, the results showed that 33.4% of adults with T2DM had signs of subclinical CVD, compared with only 16.1% of people without diabetes. After adjusting for age, elevated hs-CTnT, but not elevated NT-proBNP, was observed to be more common in people with diabetes, overall and by age, sex, race and ethnicity, and weight.

Additionally, the prevalence of elevated hs-cTnT was significantly higher in people with longer duration of diabetes and poorer glycemic control. In diabetics, elevated levels of hs-cTnT and NT-proBNP were independently associated with all-cause mortality (adjusted relative risk [aHR]1.77; [95% CI, 1.33 – 2.34] and HR, 1.78 [95% CI, 1.26 – 2.51), and CVD mortality (aHR, 1.54 [95% CI, 0.83 – 2.85] and aHR, 2.46 [95% CI, 1.31 – 4.60]).

Based on these results, the investigation team pointed out that screening for certain cardiac biomarkers should be added to the routine assessment of traditional cardiovascular risk factors.

“The biomarkers analyzed in this study are very powerful in systematically categorizing patients based on their health status,” Selvin said.² “Measuring biomarkers more regularly can help us focus on preventive cardiovascular therapies for people with T2D who are at higher risk.”

The references

1. Fang M, Wang D, Olive Tang, et al. Subclinical cardiovascular disease in American adults with and without diabetes. Journal of the American Heart Association. Published online May 31, 2023. doi:https://doi.org/10.1161/JAHA.122.029083
2. HeartNews. 1 in 3 adults with type 2 diabetes may have undetected cardiovascular disease. Eurek alert! May 31, 2023. Accessed May 31, 2023. https://www.eurekalert.org/news-releases/990479.